A Novel Approach for Transcatheter Management of Perimembranous Ventricular Septal Defect with a Subaortic Ridge

Figure 4

(a) Parasternal long axis 2D echocardiographic image of a 13-year-old female patient demonstrates moderate-to-large subaortic perimembranous VSD with 15% aortic override (black arrow) distal to a significant subaortic ridge (white arrow). (b) Cross-sectional parasternal long axis 2D echocardiographic image shows ADO-I (16–14 mm) closing the defect and compressing the subaortic ridge toward the IVS. (c) Modified parasternal long axis 2D echocardiographic image with color flow mapping documenting that ADO-I compresses the subaortic ridge successfully with complete closure of the VSD with no AR. (d) Left ventriculogram in the left anterior oblique (70°) and cranial (20°) projection demonstrating a moderate-to-large sized subaortic VSD with 15–20% aortic override and peak systolic pressure gradient across the LVOT of 20 mmHg. (e) Left ventriculogram in the left anterior oblique (70°) and cranial (20°) projection documents excellent device position (arrow) with a small residual shunt through it (which completely disappeared at follow-up). (f) Aortogram in the lateral (90^o) and cranial [20] projection demonstrating no AR despite mild prolapse of the RCC. The peak systolic pressure gradient across the LVOT decreased to 10 mmHg.

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